As we have discussed in earlier blogs, people have been looking at ways to make money with Twitter; mostly using it as a “real-time” advertising medium.  For example; Kogi Korean taco truck, L.A.’s culinary obsession.  They send Tweets to let everyone know where they are going to be and their customers flock to their location.  Well now it’s time for Twitter to make its money.

There will be two “pillars” to Twitter’s business model, Chief Operating Officer Dick Costolo said at the company’s Chirp developer conference in San Francisco. The first; promoted Tweets, which lets advertisers pay for sponsored tweets that appear at the top of search results for certain keywords.  The second pillar will be commercial accounts which will allow a business to pay for a Twitter account in return for detailed analytics tools and the ability for several people to post to the same account, currently in beta testing. 

I am not sure how “Promoted Tweets” will work since some businesses, i.e., Kogi Korean, are already creating their own promoted Tweets.  Promoted Tweets show up today only in searches, Costolo said, (not quite right).  Location-based information will likely follow, he said, allowing Starbucks to show a Promoted Tweet to users in a particular city, for example (already being done).

It’s a simple plan but, Twitter has the tendency to be a commercial anyway.  Secondly, how do they plan to post advertising on something that users believe is an ad-free service.  It also begs the question of what is Twitter going to do with the personal information it gleans about users’ habits and interests from their Twitter feeds.  A goldmine of personal information; Twitter feeds reveal so much about peoples’ interests, taste in music and more.  Costolo called it a “real-time social interest graph” — a pool of valuable information about the topics its users are currently interested in.  A potential backlash may occur if they don’t respect users’ privacy.

Twitter will split the revenue it gets from Promoted Tweets 50-50 with third parties that take part, after it has subtracted various infrastructure costs and other expenses that will probably amount to 8 or 9 percent, he said.

Twitter will sell Promoted Tweets initially using a traditional CPM model, in which advertisers pay for the number of times their sponsored tweet is viewed. But it will soon move to a more complicated model that Twitter calls “resonance,” which has to do with how many times a tweet is viewed, retweeted, replied to or marked as a favorite.

These guys are pretty smart.  They are rolling all of this out at an intentional slow pace.  This will provide for feedback and adjustments to their plan on the fly and eliminate any shock factor if they just ‘crammed’ it down tweeters’ throats.  Regardless, the folks at Twitter have created quite a system and have patiently waited for their payday.  One thing is for sure; Twitter is Going to Make Money Off of You; Are You Going to Make Money Off of Twitter?

—Marty Hudson

PCWorld’s article from April 17^th discusses the slow down of Twitter’s growth.  I am not certain the “slow down” of growth equates to Twitter going away.  After all, its popularity sky-rocketed over the last year or two; theoretically, something can only add users for so long and we just run out of people.  So, the fact that Twitter’s growth went from 20 percent at a peak in 2009 down to .15 percent at the end of the year doesn’t mean its going away; it merely means its not adding users at the same pace. 

In a blog several weeks ago I talked about Twitter sustaining itself as it currently exists.  My opinion is it needs to evolve into something else.  (http://www.medicalgpsblog.com/?p=77)

In support of this was a comment left on the PCWorld site: “I continue to lose interest day by day. Why? For starters, it’s populated by spammers and 99.9 percent of my DMs are junk. Secondly, more and more people are using Twitter to broadcast only what they want to say, not engage in conversation.”

Check out the PCWorld article: http://www.pcworld.com/article/194451/has_twitter_lost_its_tweetness.html?tk=rss_news

I also blogged about using Twitter in business and how that may be the sustainable market. (http://www.medicalgpsblog.com/?p=94)

In next week’s blog we will discuss this a little further and focusing on a PCWorld article about Twitter’s new business model.  In the meantime, how do you use Twitter?  What do you thing about PCWorld: “Has Twitter Lost its Tweetness?”

—Marty Hudson

Real healthcare reform could take place. 

Every doctor I have met will say they got into medicine because they wanted to help people.  Yes, they understand they can have a good income, but I also firmly believe money will not keep you doing something you don’t enjoy.  Most docs also admit they become a little more calloused after a number of years of practice.  Well, don’t we all.

Doctors are on the frontline; everyday all day.  They work long hours, are liable for their actions, but have never been able to come together as a profession.  Health insurance companies, courts, lawyers and lawsuits have routed them around for years.  And now, even more than ever, it’s the government getting their turn. 

Doctors are not the best businessmen in the world, although I have met a few that are.  But if left to them, everyone would get healthcare, insurance companies would pay a fair reimbursement for services, everyone would be able to get coverage and frivolous lawsuits would be tossed out of court. 

But for whatever reason, they can’t pull together.  It would be interesting to see if they did.  What if they said, ‘enough is enough’?  Well an urologist down in Florida is saying just that.  He posted a sign on his office door: “If you voted for Obama . . . seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Wow!  What if everyone did such?  What if docs decided they did not want to see patients that are on the public option?  Certainly would not be good for “healthcare reform.” 

I am not advocating such.  Doctors are not going to turn away a patient; there are ethical ramifications.  The doctor in Florida said he would not actually turn away a patient.  You can read the full article here:

http://www.latimes.com/news/health/healthcare/la-na-gop-doctor4-2010apr04,0,6717021.story

However, this is just one more indication of the divide that has been created in this country.  I have said it before, we desperately need healthcare reform, but I question if we are going about it right.  How can it be right if it has created such a divide?  Why aren’t doctors more involved in healthcare reform?  I think their input would be invaluable.  What If Doctors Only Knew the Power They Hold?

—Marty Hudson

Healthcare Reform is upon us.  Last week the COMMITTEES ON WAYS & MEANS, ENERGY & COMMERCE, AND EDUCATION & LABOR posted an Implementation Timeline.  Certainly not all inclusive to the bill that was passed; as the timeline is only seven pages compared to well over 2,000 pages in the bill.  Also they left out some interesting things; such as, employer responsibility for the cost of health coverage, tax on individuals for non-coverage, or surcharge (tax) on high income individuals.

Regardless, I think it important we understand everything we can about the bill and how it will impact all of us.  So, here is the link to the Implementation Timeline. 

http://docs.house.gov/energycommerce/TIMELINE.pdf

My suggestion is to get all in the information you can.  Does not seem there is one place to get it, even finding the most recent copy of the bill is difficult, and amendments are not incorporated that I can find.  No one is going to cover all the facts since every news agency and government office all seem to have their own agenda for what to get out there.  For now all we are going to get are various renditions of Healthcare Reform at a Glance; Not Enough, But Take it as You Can Get It.

—Marty Hudson

Well, it’s happened.  My blog back on January 12^th, “Let the Lawsuits Begin!”, has come to pass.  This week officials from 14 states filed lawsuits to block the healthcare reform bill.  Thirteen of those officials filed suit in a federal court in Pensacola, Florida, minutes after Obama signed the Patient Protection and Affordable Care Act. The complaint calls the act an “unprecedented encroachment on the sovereignty of the states” and asks a judge to block its enforcement.  The State of Florida was joined by Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota Texas, Utah and Washington. Virginia’s attorney general, Ken Cuccinelli, filed a separate case in his state Tuesday afternoon. 

Other states have come out and said they would not pursue lawsuits including Airizona, Kentucky and Georgia; although Georgia Republican Governor Sonny Perdue petitioned Democrat Attorney General Thurbert Baker to join the lawsuit filed by the thirteen states mentioned above.  To take it even a step further, Georgia lawmakers reacted to Wednesday’s news that Baker, would not sign on to the lawsuit by filing papers to have him impeached.  Its unlikely impeachment would be successful.  Usually the requirements for such are pretty high.

20-20 hindsight, my blog in January said in reforming healthcare we need “…to take the time to do it right; get it right; and get support.”  OK, so that didn’t happen.  It didn’t take a genius to figure out what was next; lawsuits.  After all, it is the American way. 

Now some of the stuff going on, violence, threats and destruction of property is just wrong.  That is not an acceptable response.  I am not a big fan of lawsuits either, but sometimes it is the best alternative.  Bottom line, if you don’t like what they are doing in government (federal, state, local, or your school board), do something about it.  Get out and vote!  If you don’t vote, don’t complain.  I don’t care if you’re Democrat, Republican, Independent or some other party, go vote.  And don’t vote for the incumbent just because you don’t know who else to vote for.  Do some homework and vote for the best candidate.

There’s my patriotic spiel.  But now that healthcare reform passed, how will lawsuits affect it going into effect?  Will some judge order it be put on hold?  Can that happen?  Will it be months or years before reform actually happens?  Could it be repealed before it ever goes into play?  I don’t know, but one thing’s for sure what we didn’t want or need…Healthcare Reform Gone Wild!  What’s next?

—Marty Hudson

Recently I read a short article by Chuck Lauer, former publisher of Modern Healthcare and an author, public speaker and career coach, titled 10 Points on Leadership.  I am listing them here in Letterman style.

10. Have courage. Leadership requires courage. Leaders have to go beyond just taking care of their own careers. They need to engage in calculated risks that will secure the future of the whole organization. This is especially important in these trying times, when healthcare, and business in general, is facing so many enormous challenges.

9. Leadership isn’t for everyone. Not all that many people want to take the hard hits that leaders have to absorb, regardless of whether they run a hospital, a clinic or a restaurant. A study of graduate students several years ago showed that well over 60 percent did not want the responsibility of being a leader. While there are many talented people, only a select few will embrace a leadership role.

8. Share credit. Leaders know the value of giving credit to others, even as they step forward immediately to take the blame for losses, so that their people are protected and valued. “A leader is best when people barely know he exists,” the Chinese philosopher Lao Tzu said. “When his work is done, his aim fulfilled, they will say, ‘We did it ourselves.’ ”

7. Embrace responsibility. Outstanding leaders come in all shapes and sizes, from a variety of backgrounds, but what really sets them apart is their enjoyment in taking on responsibility and willingness to make tough decisions when necessary. Leaders don’t waffle or equivocate. They make sure their decisions are fair-minded and balanced.

6. Be transparent. Great leaders don’t believe in secrecy or closed-door meetings. They must conduct themselves with transparency and openness so that rumors don’t start and employees don’t feel shut out. Leaders who are frank rather than evasive — even about difficult issues — will be able to win employees’ trust.

5. Demonstrate integrity. Successful leaders recognize that the way they behave reflects the principles and ethics of the organization. Integrity and ethics are essential for any leader. A leader cannot just be “one of the boys.” Leaders need to stand above the rest and show the way.

4. Choose a clear mission. Leaders make sure the mission of their organization is plainly articulated and followed day in and day out. A mission statement can sound nice and look really good, but it has to be more than a bunch of words. It should be the very heart and soul of what the organization is about. It should inspire and direct.

3. Cherish and respect employees. Leaders function as enablers, helping employees perform their jobs to the nth degree. A leader can only get work done through other people. Employees who get respect will produce at their highest capacity and make the leader look good. Make sure people have the tools to do their jobs — and the freedom to make mistakes!

2. Don’t live in a bubble. Great leaders listen to their people, obtaining a variety of perspectives from a variety of sources. This helps them distill their own decision-making. They ask employees what they think and probe them on the pros and cons of a proposal. This not only shows employees that they are valued but also gets the leader closer to the best solution.

1. Leading is not the same as managing. There is a huge difference between managing and leading. “Leaders do the right thing and managers do things right,” it has been said. While managers focus on working toward the organization’s goals, orchestrating resources in an effective and efficient manner, leaders need to engage in strategic thinking. They need to pay less attention to details and focus on the big picture.

            By Chuck Lauer

So, there is nothing wrong with being a manager, but not a leader.  It’s important to understand what you are.  Don’t try to be something you are not.  Know your talents, gifts and strengths and utilize them and do what you do best.  There is no right or wrong answer, but the question remains, Do You Manage or Lead?

—Marty Hudson

There may be more change in how things are being done because of the economy, affected by the growth in unemployment, than I can remember in my working life.  To cope and stay ahead of the curve you have to stay on your toes.  Beliefs that may have gotten you by in the past just won’t cut it today.  Here are just a few things to keep in mind as you deal with your unique, ever-changing situation.

Recognize ‘Myth’ vs. ‘Reality’.

Myth – I can just keep on doing my job like I have been.

Reality – If the company is changing, you probably need to be changing too.

Myth – I don’t think my job will be affected by all the changes.

Reality – Pay very close attention to what’s going on around you – if the company is changing at a faster rate than you are, you could be headed for trouble.

Myth – We’ve been doing it this way for years, and it seems to be working. 

Reality – Examine your work routines, your modus operandi, and see if you’re out of step with the new beat in the organization.  During times like these the cadence changes.  Work needs to move at a faster tempo.  Problems can hit in a hurry and easily outrun you.

Myth – I don’t see any reason why I should change the way I’m doing things.

Reality – If you see changes in the corporate culture, priorities, management style, or work pace in the organization, take it as hard evidence that you probably need to start doing some things differently yourself. You can’t rely on the old tried-and-true approach during periods of major transition and change.

Myth – Why fix something that ain’t broke.

Reality – “If you have always done it that way, it is probably wrong.” –Charles Kettering

Look at Yourself

• The first chore in managing change is the toughest:  Self-management.  Handle that right, and you’re halfway home.
• Examine your own attitude. 
• Evaluate your personal investment in pushing for change.
• Sometimes the best management tool is a mirror.

The Passion of the Person in Charge

• People always look at the leader when they want to take the pulse of an organization.
• Commitment climbs when people see passion in the person out front.
• The more consuming the leader’s commitment, the more they draw your people toward them.
• If you are in Charge; like it or not, you set the climate.  People always take a reading on the person in charge.
• If leadership is lukewarm, you’ll see the passion cool among your people.
• Commitment can’t survive when the leader doesn’t seem to care.
• If you are in Charge, be obvious.

Keep your Sense of Humor

• An upbeat attitude and good sense of humor won’t keep you from getting hit by trouble, but they’ll help you handle it if you do get hit.  “They said cheer up, things could get worse.  So, I cheered up and sure enough, things got worse.”
• Humor is good therapy.
• Humor helps keep things in perspective.
• Humor helps keep you from blowing all the aggravations out of proportion.
• Crying may be cleansing, but humor is healing.  Choose laughter. 
• “Enjoy yourself.  If you can’t enjoy yourself, enjoy somebody else.” –Jack Schaefer (Author, Shane)

Don’t Let Your Strengths Become Weaknesses

• The winds of change reshape circumstances and present different problems.
• Even if your job title and duties remain the same, the situation may call for something new out of you.
• Shift your job’s priorities to match the changes in organizational priorities.
• Align yourself with any changes in values and corporate culture.
• Adjust your approach to fit the personality and management style of new leaders.
• Develop new competencies if your skills become outdated.
• Be alert.  Catch on.  Refocus rapidly.
• Examine your job and identify the critical few, make-or-break factors important for job success.  Chances are something there has changed.
• Continuing to focus on “doing what you do best” might be one of the worst things you could do.
•  “Only those who constantly retool themselves stand a chance of staying employed in the years ahead.” –Tom Peters.
•  “As you’re the only one you can really change, the only one who can really use all your good advice is yourself.” –John Roger and Peter McWilliams.

Maybe you can apply some of these thoughts.  Certainly a lot of it I can apply in my own work life.  Whether it’s something posted here, or perhaps something else you have seen, read, noticed or witnessed.  Let’s hear from you; How are You Managing in these Changing Times?

—Marty Hudson

We have all heard the best offense is a good defense.  Well in the case of the health of American citizens this just isn’t the case.  To be honest this was a little bit of a new one to me, although common sense would tell you it is all too common.  On Jackson Healthcare website this past week the following article was posted.

Physicians attribute 26 percent of overall healthcare costs to the practice of defensive medicine according to a study released today by Gallup and Jackson Healthcare.

Physicians generally estimate that defensive medicine costs are higher overall when compared to their own personal practice. While physicians attribute an average of 26 percent of overall costs to defensive medicine, 13 percent believe the practice constitutes 50 percent or more of the cost.

Of the physicians surveyed, 73 percent agreed that they had practiced some form of defensive medicine in the past 12 months. Twenty-three percent of practicing physicians estimate that defensive medicine constitutes less than 10 percent of their practice while 29 percent estimate the percentage to be between 10 percent and less than 25 percent.

Physicians indicating they had practiced a form of defensive medicine in the last twelve months attribute 21 percent of their practice to be defensive in nature.

In the study, defensive medicine was defined in this manner:  “Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. This may include tests, prescriptions, hospitalizations and referrals that may not be medically necessary, but are viewed as providing protection from a potential lawsuit.”

Jackson Healthcare retained Gallup for the study in an effort to quantify the scope and impact of defensive medicine practices in the U.S.

Results are based on telephone interviews with 462 randomly selected US physicians. Interviews were conducted in December and January.

—Credit Jackson Healthcare & Gallup

So all that said; as stated in the past on this blog, there are some real healthcare reform needed in this county and I am not sure we are focusing reform on where it needs to be.   Best offense is a good defense?  In this case, playing defense isn’t even in the best interest of Americans’ health.

—Marty Hudson

At the one year anniversary of the economic stimulus plan President Obama declares the economic stimulus plan an unequivocal success that has created or saved millions of jobs.

On the other hand, critics are pointing out a continuing dismal jobs picture and deflating public confidence as signs that the stimulus bill, as one GOP leader put it, was “fiction” and not worth the cost.

Recent comments from the President Obama include:  “We have rescued this economy from the worst of this crisis…”  The measure “was never intended to save every job.  Businesses are the true engine of growth [and] always will be. But during a recession … what government can do is provide a temporary boost.” The program “runs cleanly, smoothly and transparently.”  “We acted because failure to do so would have led to catastrophe. One year later, it is largely thanks to the recovery act that a second depression is no longer a possibility.”

Vice President Biden stated, “Without any question” the package is working and “laying the foundation” for long-term economic growth.

Senate Minority Leader Mitch McConnell, R-Ky., said, “In the first year of the trillion-dollar stimulus, Americans have lost millions of jobs, the unemployment rate continues to hover near 10 percent, the deficit continues to soar and we’re inundated with stories of waste, fraud and abuse.  This was not the plan Americans asked for or the results they were promised.”

There is the rhetoric.  Here are some facts. 

The United States of America owes $1.6 trillion more today than it did a year ago.  The national debt has reached nearly $12.4 trillion, while this fiscal year’s deficit is expected to hit about $1.6 trillion.

In the last year the jobless rate has climbed from 8.1 percent to 9.7 percent.  While employers may be shedding fewer jobs than last year, 49 states saw a net job loss in 2009.  A recent CBS News/New York Times survey showed only 6 percent of Americans believe the stimulus has created a significant number of jobs.

The bulk of the money initially allocated for the plan has not actually been spent yet. Through the end of January, roughly $334 billion in spending has been approved, of which only $179 billion has actually been released.  Another $119 billion has gone to tax cuts.  Now that the economy is no longer in free fall, the mix of spending will change, senior administration officials said. Until this point, the bulk of the spending has been on tax relief and direct aid, such as unemployment benefits.  To date, only $31 billion has been spent on projects such as infrastructure, high-speed rail, broadband and health technology.  

So, if the bulk of the Economic Stimulus hasn’t even been spent, how can they tout that it’s working? 

You tell me – The Economic Stimulus Plan – What Changes Have You Seen?

—Marty Hudson

A few years ago we read a book by Fred Lee, “If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently.”  In reading the book we quickly realized our conviction in deploying M3-Patient Experience matched up with what Fred said in his book.  We contacted Fred, met him at the airport in Orlando for lunch and asked him to take a look at M3-Patient Experience.  After spending a considerable amount of time, this was his unsolicited comment:

“I liked all the questions in your survey and could honestly not think of anything I felt was not covered. It is really an electronic work of art. You are to be highly commended. I can recommend it highly, and you can quote me on that!”

With that I would like to share with you some of the points Fred makes in his book, as well in presentations he makes to healthcare operations around the country.

Focus on What Can’t be Measured.  When we focus on the perceptions of the patient the efficiencies will follow.  In other words, when we treat the patient with compassion, we will meet the patients’ needs efficiently and effectively.  Every patient is different, compassion helps you focus on the need of every patient. 

Make Courtesy More Important than Efficiency.  By first being courteous to the patient, which creates an external focus (focusing on the patient’s need), bringing responsiveness to the patient’s need, which promotes sharing of resources, and ultimately results in overall organizational efficiency and teamwork; creating a memorable experience for the patient.

Measure to Improve, Not to Impress.  When we measure the patient’s experience with the focus on improvement, understanding each patient is different, we continuously find ways to get better.  If we are merely measuring to impress we are more focused on average scores and if we are at least better than someone else, when “someone else” might be pretty bad.  Continually improve and your patients will not only be impressed, but will be loyal.

Closing the Gap between Knowing and Doing.  “Like losing weight, our problem is not with knowing how. When we want to enough, we figure out how and learn by doing.  Our problem is with being committed enough to do what it takes every day, and do it permanently, not just in short bursts of inspired energy.” — Fred Lee

Here is a link to a slide show from some of Fred’s speaking engagements I found posted on the web:  http://tinyurl.com/fredleeifdisney.  I encourage you to read his book.  But most importantly when providing care to your patients I challenge you to improve continuously and ask yourself, “What Will I Do Differently?”

—Marty Hudson